Re-dislocation rate after primary open reduction: 0-14% [1] Causes and timing of failure of primary surgery: Postoperative period Causes Immediate Approach related, Technical errors Delayed (After 4-6 weeks) Inadequate capsulorrhaphy, Inadequate immobilization Late Abnormal remodeling of acetabulum and femur Across multiple studies, inadequate soft tissue release – specifically the psoas…
Author: Dr. Sulabh Kumar Shrestha, MS Orthopedics
He is the section editor of Orthopedics in Epomedicine. He searches for and share simpler ways to make complicated medical topics simple. He also loves writing poetry, listening and playing music. He is currently pursuing Fellowship in Hip, Pelvi-acetabulum and Arthroplasty at B&B Hospital.
PGMEE, MRCS, USMLE, MBBS, MD/MS
Bone Cement : Basic Science
COMPOSITION Powder Liquid Polymer: PMMA Monomer: MMA Initiator: BPO Accelerator: NN-DMPT (Dimethyl paratoluidine; encourage polymer and monomer to polymerize at room temperature) Radiopacifier: BaSO4/ZrO2 Stabilizer: Hydroquinone (prevent premature polymerization) Antibiotics: Gentamicin +/- Cross-linking agent (improves mechanical strength): e.g., ethylene glycol dimethacrylate (EGDMA) POLYMERIZATION MECHANISM Free radical polymerization: Initiator in powder…
Fellowship Blog
Mathematical Principles in Mechanically Aligned Total Knee Arthroplasty
Mechanical Axis Concept Natural Knee Target alignment in MA-TKA Tibial cut Distal femoral cut Posterior femoral cut The 3° Compensation Rule Distal femoral and Tibial resection thickness = Implant thickness 2 mm rule in TKA References:
Surgical Skills
S1 Iliosacral screw (ISS) fixation : Technique
Indications Entry point Anterior in S1 body and inferior to the overlapping iliac cortical density (ICDs) in true lateral projection Trajectory Dangers
Fellowship Blog
Refracture of the Patella – Early TBW Failure and Re-fixation
One month following an index TBW procedure (using 4 K‑wires + cerclage), our patient sustained a refracture of the patella after a fall. There was no high-energy direct trauma. This case typifies early failure of a classic TBW construct. Failure Factors Identified in Literature Revision Fixation Alternate Techniques Key Takeaways…
Fellowship Blog
Tibial Shaft Fracture Fixation in Osteogenesis Imperfecta – Lessons from a Challenging ORIF
A 15-year-old male with osteogenesis imperfecta sustained a left tibial shaft fracture. We performed open reduction and intramedullary interlocking nailing (IMIL nail 8 mm). Intraoperatively, we encountered multiple iatrogenic fractures and longitudinal splits due to the brittle nature of OI bone. On postoperative review, the entry point appeared slightly lateral…
Fellowship Blog
Approach to Pelvic Ring Injury Classification
Introduction Existing Young-Burgess (YB), Tile & AO/OTA classification systems for pelvic ring fractures demonstrate inconsistent and often only fair-to-moderate inter-observer reliability (kappa = 0.30–0.79), creating diagnostic variability that can impact treatment planning and communication among orthopedicians.1 A clear, stepwise, unified algorithm could improve trainee education, standardize radiographic interpretation, and aid…
Fellowship Blog
The 0-3-6-9 rule in Mechanical Alignment Total Knee Arthroplasty (MA-TKA)
The goal of MA-TKA is to restore the normal mechanical axis. In contrast to kinematic axis alignment, which attempts to recreate native knee joint line (3° tibial varus and 3° femoral valgus), in MA-TKA, the distal femur and the tibia are cut to be perpendicular (0°) to the mechanical axis….